Doing it for themselves: Peer-led HIV testing in Viet Nam improves access to care

7 May 2018

Tran Minh Hoang gets ready to take an HIV test with Dang Quoc Phong in Can Tho, Viet Nam
WHO/O. Lawe-Davies

On Tuesday nights, Dang Quoc Phong and his friends get together at a café in Can Tho, Viet Nam. They’re not just there to drink coffee and catch up—some are getting tested for HIV. “Guys like coming here because they feel more comfortable, and it’s convenient to be able to pass by after work or classes,” says Phong, a peer leader within a community of men who have sex with men (MSM).

A few blocks away, on Wednesday mornings, Le Thi Phung and Duong Ho Hue Tam, who are female sex workers (FSW), welcome others in their industry to their house to drink tea, talk and get an HIV test if they want.

Free HIV testing has been available in hospitals and clinics across Viet Nam since 2012, but getting the people at highest risk of infection to come to a facility for testing has proved difficult. Data from 2016 show that only 36% of people who inject drugs (PWID), 41% of MSM, and 43% of FSW had ever been tested for HIV. The government of Viet Nam is aiming for the global target of 90% of people living with HIV knowing their status by 2020. This is one of the ways in which Viet Nam is making progress towards universal health coverage—ensuring all people get the health services they need, where and when they need them, without financial hardship.

In 2016-2017, the Viet Nam Authority for HIV/AIDS Control partnered with WHO to pilot community-based HIV testing in two provinces—one in the south and one in the north—making it one of the first countries to adopt WHO recommendations aimed at reaching people who are not getting tested for HIV in health facilities.

Duong Ho Hue Tam does an HIV test for a female sex worker in Can Tho, Viet Nam
WHO/O. Lawe-Davies

In the pilot, peer leaders—not health workers—from the MSM, FSW and PWID communities were trained to use both oral swab and finger prick kits and to counsel their peers to test. Last year, 2520 people at risk of HIV in Thai Nguyen and Can Tho provinces were supported by a peer to get tested. Among those, 140 people were diagnosed with HIV, and 131 of them started treatment.

In 2017, community-based testing identified 60% of all newly-diagnosed HIV cases in Thai Nguyen and 30% of new cases in Can Tho. Nearly 70% of the people who took an HIV test in the pilot were first-time testers. This suggests that the community-based approach is achieving its goal of “reaching the unreached”.

The pilot has been so promising that testing and counselling of partners of people who tested positive for HIV has been added to the service package offered by peer leaders. Of the 68 partners tested in 2017, 27 were also confirmed to be HIV-positive and 25 started treatment.

This innovative approach is breaking down barriers to care for people who need it most.

Dr Kidong Park, WHO Representative in Viet Nam

“The peer leaders in Thai Nguyen and Can Tho are helping people within their communities to find out their HIV status and get started on treatment when necessary,” said Dr Kidong Park, WHO Representative in Viet Nam. “This innovative approach is breaking down barriers to care for people who need it most.”

WHO has worked closely with the Government to ensure peer educators get the training, monitoring and support they need to provide high quality services. The local government has mobilized resources to ensure peer educators get an allowance to cover their costs. This is essential to the sustainability of community-based HIV testing, to ensure it can continue after the pilot is completed.

Viet Nam is aiming to end transmission of HIV and make progress towards universal health coverage, in line with global goals. While there is still a way to go, the commitment of peer leaders like Phong and Phung is changing lives and showing how engaging communities can make a difference.